Neurocysticercosis: Combined Treatment with Praziquantel and Albendazole

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DESCRIPTION (provided by applicant): Taenia solium neurocysticercosis is the single major cause of acquired epileptic seizures in the world, and a common diagnosis in immigrant populations in the USA and other industrialized countries. We have demonstrated that the prognosis of the associated seizure disorder improves by killing brain cysts using anti-parasitic treatment. Cyst death is not the direct result of the drug but actually results from the host's immune system destroying the parasite after antigenic exposure caused by treatment-associated damage. Current regimes of antiparasitic treatment offer only partial efficacy, killing 75% of brain cysts or less. We hypothesize that combined treatment with two different anti-parasitic drugs will improve clearance of brain parasites and thus provide better cysticidal efficacy, and will perform a double-blind, randomized clinical trial to determine if a 10-days combined regime of regime of praziquantel (PZQ) and albendazole (ABZ) improves the parasiticidal efficacy of ABZ alone at the same dose and length of treatment. A secondary aim to be examined is also whether complete cyst destruction (patients free of any viable cysts) is associated with fewer seizures in a 18-months follow up period. There will be two associated substudies: i) pharmacokinetics of ABZ and PZQ in patients with neurocysticercosis, and ii) immunological markers of complete cure after treatment for neurocysticercosis. The parent study will determine the benefits of combined antiparasitic therapy in terms of parasiticidal effect and control of seizures. This mode of therapy would have worldwide applicability. The two sub-studies should add useful data on the pharmacokinetics of the drugs and assess the possibility of early prediction of complete cure.